CMS/EIP Fiscal Report Center: 04
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 2 0.500000 22.8400 45.6800
TCM-T1017TL-TARGETED CASE MANAGEMENT 95 167.000000 7622.2000 45.6419
Subtotal (Total Children Is Unduplicated) 96 167.500000 7645.0400 45.6420
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Screening, Eval, and Assessment,Class #02
OCTH-97165-OT EVAL LOW COMPLEXITY 7 7.000000 366.4400 52.3486
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 4 4.000000 232.4400 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 174.3300 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 290.5500 58.1100
Subtotal (Total Children Is Unduplicated) 21 21.000000 1179.9800 56.1895
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 52.750000 2637.5000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 87 566.000000 15282.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 919 6320.000000 341280.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 10 48.000000 2592.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 781 5383.000000 80745.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 198 1083.000000 12996.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 22 51.250000 3777.6900 73.7110
OCCT-97530HM-OT SESSION BY OT ASST 38 154.500000 10061.0400 65.1200
PHY-97110-PT SESSION BY LICENSED PT 39 80.500000 6546.2600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 56 162.500000 10582.0000 65.1200
PHY-97110TLHM-PT SESSION BY PT ASST 1 6.000000 390.7200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 66 215.500000 17524.4600 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 8 36.500000 2376.8800 65.1200
Subtotal (Total Children Is Unduplicated) 1041 14159.50000 506791.5500 35.7916
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Total 14348.000000 515616.5700 35.9365
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Number of Children (Unduplicated) With at Least One Service 1090
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Center 04
Flag Claims Units Chgs Paid
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R 23 24.500000 1119.1600 0.0000
U 0 0.000000 0.0000 0.0000
B 94 101.250000 4625.1000 0.0000
P 8176 8140.500000 184502.7400 184158.6700
D 1 0.750000 27.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 4912 4911.750000 266572.7200 0.0000
T 0 0.000000 0.0000 0.0000
1700 1145.250000 57133.6000 0.0000
Other 24 24.000000 1635.3500 15.0000
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Total 14930 14348.000000 515616.5700 184173.6700